Penile Rehabilitation & Prehabilitation
What is Penile Rehabilitation?
Penile rehabilitation is a structured, treatment approach tailored to the individual patient to ensure they have the best possible chance of restoring function, confidence and intimacy.
It is designed to preserve erectile function, maintain penile length, and protect tissue quality following prostate cancer treatment, pelvic surgery or during radiation therapy and/or androgen deprivation therapy (ADT). Rather than waiting to see if erectile function recovers naturally, penile rehabilitation is proactive—aiming to optimise recovery and prevent irreversible damage to erectile tissue.
The penis is a unique organ that maintains its tissue health through regular, spontaneous erections, including the morning erections most men are familiar with. These natural cycles ensure adequate oxygenation of erectile tissue, keeping it functional and elastic.
However, when the nerves controlling these erections are disrupted—whether by surgery, radiation, or other causes—this critical oxygenation process is impaired. Without intervention, this can trigger a cascade of changes, including:
Veno-occlusive dysfunction (difficulty maintaining erections due to poor blood trapping).
Penile atrophy (shrinkage and tissue loss due to prolonged disuse).
Progressive erectile dysfunction (ED) that worsens over time.
These changes can occur even after nerve-sparing procedures or focal therapy.
Penile rehabilitation is designed to break this cycle by restoring blood flow, preserving tissue quality, and improving the chances of erectile function recovery. For men who do not respond to conservative therapies, early intervention with a penile prosthesis can prevent irreversible damage, ensuring they regain both function and confidence.
When should Penile Rehabilitation start?
Early intervention is key.
Ideally, patients are seen 1 month before the initiation of treatment that can render them impotent. The greatest risk of irreversible penile changes occurs in the first 3 months following treatment.
Otherwise, penile rehabilitation should be initiated within the first month after surgery or other treatment that reduces erectile function.
Penile rehabilitation care should run in parallel to radiation or hormone therapy for prostate cancer.
Why is this important?
Time matters. The longer the penile tissue remains deprived of oxygen-rich blood flow, the greater the risk of permanent changes that make later treatment less effective. Men who do not engage in penile rehabilitation can lose 0.5–5 cm of penile length per year due to progressive atrophy.
If erectile function is restored with a penile prosthesis after these changes have occurred, patient satisfaction is lower as many no longer recognise their penis anymore.
Rehabilitation should occur in parallel with prostate cancer treatment, not as an afterthought. The sooner we intervene, the better the outcomes.
It is important to remember that prostate cancer screening and early treatment saves lives. However, prostate cancer care extends beyond survival and there are options to help individuals and couples restore a happy and fulfilling life. Intimacy is not a luxury or an afterthought, it’s a basic human need.
Men with venous leak also have a higher risk of experiencing penile atrophy. Where the length and girth decrease and shape can permanently change. It is essentially to differentiate men with arteriogenic and veno-occlusive dysunction, as the latter are best managed with a penile implant. This not only prevents men from going on the round-about of ineffective and costly treatments, but also prevents penis atrophy from occurring or progressing.
A Penile Duplex Ultrasound is the most reliable test for identifying the vascular causes of erectile dysfunction. Ideally, this test should be performed around three months after any treatment that may impact erectile function. For men undergoing penile rehabilitation, Dr. Ross Calopedos performs this quick, in-clinic assessment to make sure ongoing rehabilitation efforts are effective and do not carry risk of progressive atrophy, seen in specific vascular causes of ED. Understanding the underlying cause is key to preventing complications and providing treatments that work.
What does Penile Rehabilitation involve?
A personalised treatment plan is created based on each patient’s intimacy goals, their function before treatment, the type of treatment they received and how they respond to therapy. Common strategies include:
1. Phosphodiesterase Type 5 Inhibitors (PDE5i) (Viagra, Cialis)
Stimulates blood flow to penile tissue, supporting natural recovery.
Should be started before and continued throughout therapy to promote tissue oxygenation.
May not restore functional erections alone, but supports vascular health when used in combination with other therapies.
2. Intracavernosal Injections (ICI) (Alprostadil (Caverjet), Bimix, Trimix, Quadmix)
Medication administered directly to the site of action.
For men who do not have functional erections with PDE5 inhibitors.
When administered using the correct technique, ICI can prevent fibrosis and atrophy by maintaining penile expansion and may produce erections hard enough for penetration.
3. Intraurethal gels
The same medications in ICI, however, are less effective in more resistant cases when compared to injections.
3. Vacuum Erection Devices (VEDs)
Creates erections by drawing blood into the penis. It can limit shrinkage via tissue expansion, however it does not address reduced tissue oxygenation.
4. Penile Traction Therapy (PTT) (RestoreX, Andropenis, Phallosan Forte)
Purpose: Maintains penile length and reduces risk of shrinkage or deformity and can improve tissue oxygenation if vascular supply is intact.
5. Penile Duplex Ultrasound (at 3 months post-surgery)
Assesses penile blood flow and veno-occlusive function.
At 3 months, if patients remain unresponsive to medical therapy and the duplex ultrasound confirms veno-occlusive dysfunction, they are unlikely to benefit from ongoing medical treatments and face a significant risk of penile atrophy
6. Early Penile Prosthesis Implantation (for non-responders)
Purpose: Permanent, guaranteed solution for men who wish to expedite their sexual function recovery and for those not responding to medical management.
Benefits: Prevents penile atrophy, restores erectile function, and provides on-demand erections.
Timing: To avoid irreversible changes in the penile structure, early penile implant should be considered if:
No response to rehabilitation by 3 months and ultrasound demonstrates veno-occlusive dysfunction.
No response to medications or injections at 3-6 months
Penile Prehabilitation: Maximise Recovery
Penile prehabilitation prepares erectile tissue for surgery or any other treatment that affects erectile function, improving post-operative outcomes.
What does Prehabilitation involve?
✓ PDE5 inhibitors, injections, or VEDs before surgery to enhance blood flow (Depending on baseline erectile function)
✓ Optimising testosterone levels (if low and if safe to do so)
✓ Pelvic floor exercises (Kegels)
✓ Lifestyle modifications (weight management, smoking cessation, cardiovascular fitness).
Prehabilitation ensures men enter treatment in the best possible condition, improving chances of erectile recovery.
What if Penile Rehabilitation isn’t helping restore my Erections?
If you’re not seeing progress 3-6 months after prostate cancer treatment, don’t wait years hoping for improvement. Don’t get sucked into ads offering a quick fix.
Men who want to return to penetrative sex with guaranteed, firm, long-lasting erections should consider penile implant surgery.
Penile implants restore sexual function with the simple activation of a pump discreetly placed in the scrotum.
Best outcomes occur within 12 months post-surgery—before irreversible penile shortening occurs.
The problem isn’t that treatment doesn’t exist—it’s that men aren’t referred early enough. If you’ve had prostate cancer treatment and are struggling with ED, this is NOT something you have to live with. Dr. Ross can help.
Without rehabilitation, men with post-surgical ED can lose 0.5–5 cm in penile length annually.
Once penile fibrosis develops, it becomes irreversible.
Men who remain unresponsive to medical therapy at 3-6 months should be considered for definitive ED treatment.
Why early intervention matters
When to see a doctor
At Dr Ross’s clinic, we focus on preserving penile function, optimising recovery, and providing long-term solutions for men who want to regain their confidence, sexual health and intimacy.
If you’ve undergone prostate cancer treatment, colorectal surgery, other pelvic interventions or radiotherapy, don’t wait - early penile rehabilitation can make a significant difference.
Ask Dr Ross.
If you are not ready to make an appointment, but would like to ask a question or get some more information, we are here for you.
BOOK A CONSULTATION FOR PENILE REHABILITATION TODAY
Early penile rehabilitation can make a significant difference.
Contact us to discuss a personalised rehabilitation plan and take the first step toward recovery.
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